Surgery

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A typical modern surgical operation

Surgery (from Greek: cheirourgia, meaning "hand work") is the medical specialty that treats diseases, injuries, or other physical conditions by operative manual and instrumental treatment. Surgeons may be physicians, dentists, or veterinarians who specialize in surgery.

A surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.

For many physical ailments, surgery offers an effective and efficient treatment, and sometimes is the only viable alternative. For other ills of the physical body, a more comprehensive approach to medicine may be recommended, including complementary and alternative medicine, which can involve non-invasive, non-pharmaceutical techniques. Some non-essential surgical techniques, such as clitoridectomy, circumcision, and some cosmetic surgeries, are based on cultural, religious, or personal choice issues rather than medical reasons (see list of surgical procedures).

Contents

History of surgery

The earliest known surgical procedure is trepanation, which is also known as trephinning or trepanning. In this procedure, a hole was drilled or scraped into the skull, leaving the membrane around the brain intact. A trepanned cranium found near Kiev, Ukraine is the oldest yet found, dating back to 7300-6220 B.C.E. Trepanation attempted to address health problems that related to abnormal intracranial pressure, headaches, and mental illnesses. It has been found in cultures around the world. Modern surgery has largely abandoned this practice, although it is still used in cases of acute subdural hematomas and acute epidural hematomas, with hematoma being a collection of blood.

Researchers have also uncovered an ancient Egyptian human mandible dated to approximately 2800 B.C.E. The mandible, having two perforations just below the root of the first molar, indicates the draining of an abscessed tooth. Recent excavations of the construction workers of the Egyptian pyramids also led to the discovery of evidence of brain surgery on a laborer, who continued living for two years afterward.

As it is now known, the Edwin Smith Surgical Papyrus is a collection of valuable Egyptian history. It is an ancient Egyptian textbook on surgery and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.

In India, the Sushruta Samhita is considered one of the greatest ancient texts. It discusses traditional Indian medicine and surgery. Sushtra, thought to be the book's author, lived over three thousand years ago. As an Indian physician, he is an important figure in the history of surgery. He lived, taught, and practiced his art of surgery on the banks of the Ganges in the area that corresponds to the present day city of Benares in North-West India. Because of his seminal and numerous contributions to the science and art of surgery, he is also known by the title "Father of Surgery."

In the 184 chapters of the book, approximately 1,120 conditions are listed. Several treatments are discussed, including the use of leeches in order to prevent blood clots. After being rediscovered, this technique is now being used by plastic surgeons to help reduce blood congestion in tissue.

As surgery has changed and developed over centuries, so has the status and job of physicians and surgeons. Today, surgeons are considered to be specialized physicians. The profession of being a surgeon and that of being a physician have different historical roots, and surgeons have now even subspecialized along with physicians. For example, the Hippocratic Oath warns physicians against the practice of surgery, specifically that "cutting persons laboring under the stone," in other words, lithotomy, an operation to relieve kidney stones, was to be left to "such persons as practice [it]."

By the thirteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius Salernitanus composed his Chirurgia, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.

Among the first modern surgeons were battlefield doctors in the Napoleonic Wars who were primarily concerned with amputations. Naval surgeons were often barber-surgeons, who combined surgery with their main jobs as barbers.

In the United Kingdom, surgeons are distinguished from physicians by being referred to as "Mister." This tradition has its origins in the eighteenth century, when surgeons were barber-surgeons and did not have a degree (or indeed any formal qualification), unlike physicians, who were doctors with a university medical degree.

By the beginning of the nineteenth century, surgeons had obtained high status, and in 1800, the Royal College of Surgeons (RCS) in London began to offer surgeons a formal status via RCS membership. The title Mister became a badge of honor, and today only surgeons who hold the Membership or Fellowship of one of the Royal Surgical Colleges are entitled to call themselves Mister, Miss, Mrs., or Ms.

In contrast, North American physicians and surgeons are always addressed as "Doctor."

Development of modern surgery

Before the advent of anaesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. In addition, the need for strict hygiene during procedures was little understood, which often resulted in life threatening post-operative infections in patients.

Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. Also, the discovery of muscle relaxants such as curare allowed for safer applications.

However, the move to longer operations increased the danger of life-threatening complications since the prolonged exposure of surgical wounds to the open air heightened the chance of infections. It was only in the late nineteenth century with the rise of microbiology, due to scientists like Louis Pasteur, and innovative doctors who applied their findings, like Joseph Lister, did the idea of strict cleanliness and sterile settings during surgery arise.

Diseases that can be treated by surgery

Several diseases can be treated by surgery. A handful of such diseases are listed and/or discussed below.

Intraoperative X-ray of a Humerus fixated by Kirschner wires
  • Trauma
  • Anatomical abnormalities
  • Disorders of function
  • Inflammation
  • Ischaemia - a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue
  • Infarction - an artery leading to any tissue is blocked by some object (blood clot, cholesterol deposit, et cetera), depriving that tissue of oxygen, which causes the tissue to die
  • Metabolic disorders
  • Neoplasia - abnormal, disorganized growth in a tissue or organ
  • Other abnormalities of tissue growth, e.g. cysts, hyperplasia or hypertrophy

Noted Surgeons

  • William Stewart Halsted (initiated surgical residency training in United States)
  • Alfred Blalock (first modern day successful open heart surgery in 1944)
  • C. Walton Lillehei (labeled "father of modern-day open heart surgery")
  • Christiaan Barnard (cardiac surgery, first heart transplantation)
  • Walter Freeman (popularized the lobotomy as a legitimate form of psychosurgery)
  • Sir Victor Horsley (first physician to remove a spinal tumor by means of a laminectomy)
  • Lars Leksell (neurosurgery, inventor of radiosurgery)
  • Joseph Lister (discoverer of surgical sepsis; Listerine named in his honor)

List of Surgical Term Roots

Prefixes

  • angio- : related to blood vessels
  • arthr- : related to a joint
  • bi- : two
  • colpo- : related to the vagina
  • encephal- : related to the brain
  • hepat- : related to the liver
  • hyster- : related to the uterus
  • lapar- : related to the abdominal cavity
  • lobo- : related to a lobe (of the brain or lungs)
  • mammo- and masto-: related to the breast
  • myo- : related to muscle tissue
  • nephro- : related to the kidney
  • oophor- : related to the ovary
  • orchid- : related to the testicle
  • vas- : related to the vas deferens

Suffixes

  • -centesis: surgical puncture
  • -desis : fusion of two parts into one, stabilization
  • -ectomy: surgical removal; the term 'resection' is also used, especially when referring to a tumor
  • -oid : similar to
  • -opsy : looking at
  • -ostomy or -stomy: surgically creating a hole (a new "mouth" or "stoma")
  • -otomy or -tomy: surgical incision
  • -plasty : replacement
  • -rrhapy: suture

List of surgical procedures

According to 1996 data from the U.S. National Center for Health Statistics, 40.3 million inpatient surgical procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient surgeries. The following is a incomplete list of surgical procedures.

  • Abdominal surgery - broadly covers surgical procedures that involve opening the abdomen; the three most common abdominal surgeries are exploratory laparotomy, appendectomy, and laparoscopy
  • Abdominoplasty - "tummy tuck"; a cosmetic surgery procedure to reshape and firm the abdomen
  • Adenoidectomy - the surgical removal of the adenoids (tissue situated at the very back of the nose)
  • Amputation - the removal of a body extremity by trauma or surgery
  • Angioplasty - the mechanical alteration of a narrowed or totally obstructed vascular lumen
  • Appendicectomy - also called an appendectomy; the surgical removal of the appendix
  • Arthrodesis - also known as artificial ankylosis or syndesis; the artificial induction of joint ossification between two bones via surgery
  • Arthroplasty - literally "formation of joint"; an operative procedure performed for replacing the arthritic or dysfunctional joint surface with something better, or remodeling or realigning the joint by osteotomy or some other procedures
  • Arthroscopic surgery - a minimally invasive surgical procedure in which a physical examination of the interior of a joint is performed using an arthroscope (a type of endoscope that is inserted into the joint through a small incision)
  • Bilateral Cingulotomy - a brain surgery performed to treat chronic pain in cancer patients
  • Biopsy - a medical test involving the removal of cells or tissues for examination
  • Cauterization - a medical term describing the burning of the body to remove or close a part of it
  • Caesarean Section, also c-section - a form of childbirth in which a surgical incision is made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies
  • Cardiothoracic surgery - the surgical treatment of diseases that affect organs inside the thorax (the chest), meaning it will generally cover conditions of the heart (cardiovascular disease) and lungs (lung disease)
  • Cholecystectomy - the surgical removal of the gallbladder
  • Circumcision - the removal of some or all of the foreskin (prepuce) from the penis, generally for cultural/religious reasons rather than medical reasons
  • Clitoridectomy/Female Genital Cutting (FGC) - refers to amputation of any part of the female genitalia, generally for cultural/religious reasons rather than medical reasons
  • Colectomy - consists of the surgical resection of any extent of the large bowel (colon)
  • Colostomy - a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma
  • Commissurotomy - a surgical incision of a commissure in the body
  • Cordotomy - a surgical procedure that disables selected pain-conducting tracts in the spinal cord in order to achieve loss of pain and temperature perception
  • Cornea Transplant - also known as a corneal graft or penetrating keratoplasty; a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue
  • Dental surgery - any number of medical procedures which involve artificially modifying the dentition (the development of teeth and their arrangement in the mouth)
  • Discectomy - a surgical procedure in which an extravasated segment of the intervertebral disc, which is causing pain by stressing the spinal cord or radiating nerves, is dissected
  • Episiotomy - a surgical incision through the perineum made to enlarge the vagina and assist childbirth
  • Endarterectomy - a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of fatty deposits
  • Endoscopic thoracic sympathectomy (ETS) - a surgical procedure where certain portions of the sympathetic nerve trunk are burned, severed, removed, or clamped
  • Eye surgery/Ophthalmic surgery - surgery performed on the eye or its adnexa (the appendages of an organ)
  • Foreskin restoration - the process of expanding the skin on the penis, via surgery or stretching methods, to replace the foreskin (prepuce) covering the glans penis
  • Fistulotomy - the surgical opening or removal of a fistulus tract
  • Frenectomy - also called frenulectomy or frenotomy; the removal of a frenulum (a small fold of tissue that prevents an organ in the body from moving too far); a frenulum can occur in several places on the human body
  • Gastrectomy - a partial or full surgical removal of the stomach
  • General surgery - a surgical specialty that focuses on surgical treatment of abdominal organs, e.g. intestines including oesophagus, stomach, colon, liver, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists) and hernias
  • Grafting - a surgical procedure to transplant tissue without a blood supply
  • Hemicorporectomy - also named translumbar amputation and "halfectomy"; a radical surgery in which the body caudal to the waist is amputated, transecting the lumbar spine
  • Hemorrhoidectomy - a surgical procedure to excise and remove hemorrhoids
  • Hepatectomy - the surgical resection of the liver
  • Hypnosurgery - the term given to an operation where the patient is sedated using hypnotherapy rather than traditional anaesthetics
  • Hysterectomy - the surgical removal of the uterus
  • Laminectomy - a surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord
  • Laparoscopic surgery - refers only to operations within the abdomen or pelvic cavity; belongs to the field of endoscopy and also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS)
  • Laryngectomy - the surgical removal of the larynx and separation of the airway from the mouth, nose, and esophagus
  • Lithotriptor- a medical device used in the non-invasive treatment of kidney stones (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver)
  • Lobotomy - a form of psychosurgery consisting of cutting the connections to and from, or simply destroying, the prefrontal cortex
  • Lumpectomy - a common surgical procedure designed to remove a discrete lump (usually a tumour, benign or otherwise) from an affected man or woman's breast
  • Mammoplasty - although this can refer to cheek implants, usually made of solid silicone, which is inserted generally through the mouth and secured above the cheekbones to give more facial definition and improve the face, the term usually refers to augmentation mammoplasty, an enlarging of the breasts via implants
  • Mastectomy- the medical term for the surgical removal of one or both breasts, partially or completely
  • Mastoidectomy - an operation to remove disease from the bone behind the ear, when medical management is inadequate
  • Mentoplasty - a type of cosmetic surgery that is used to improve the appearance of a person's chin
  • Myotomy - a surgical procedure in which muscle is cut
  • Myringotomy - the incision of the tympanic membrane (or eardrum) done for variety of reasons, but usually in order to drain the middle ear of fluid or infection
  • Nephrectomy - the surgical removal of a kidney
  • Neurosurgery - provides the operative and nonoperative management (ie, prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems
  • Nissen Fundoplication - a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia
  • Oophorectomy - also called an ovariotomy; the surgical removal of the ovaries of a female human or animal (in the case of animals, it is also called spaying)
  • Oral and Maxillofacial Surgery - used to correct a wide spectrum of diseases, injuries, and defects in the head, neck, face, jaws, and the hard and soft tissues of the oral and maxillofacial region
  • Orchiectomy - also known as a castration; any action, surgical, chemical, or otherwise, by which a biological male loses use of the testes
  • Orthopedic surgery - concerned with acute, chronic, traumatic, and overuse injuries and other disorders of the musculoskeletal system
  • Otorhinolaryngology - branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders; the full name of the specialty is otolaryngology, head and neck surgery
  • Parathyroidectomy - the surgical removal of one or more parathyroid glands
  • Penectomy - the surgical removal of the penis for medical reasons
  • Phalloplasty - refers to the (re-)construction of a penis or, sometimes, to artificial modification of the penis by surgery
  • Plastic surgery - general term for operative manual and instrumental treatment which is performed for functional or aesthetic reasons; the principal areas of plastic surgery include the two broad fields of reconstructive surgery and cosmetic surgery
  • Pneumonectomy - a surgical procedure to remove a lung
  • Prostatectomy - the surgical removal of all or part of the prostate gland
  • Psychosurgery - a term for surgeries of the brain involving procedures that modulate the performance of the brain, and thus effect changes in cognition, with the intent to treat or alleviate severe mental illness
  • Radiosurgery - a medical procedure which allows non-invasive brain surgery, i.e., without actually opening the skull, by means of directed beams of ionizing radiation
  • Remote surgery - also known as telesurgery; the ability for a doctor to perform surgery on a patient even though they are not physically in the same location; combines elements of robotics, cutting edge communication technology, and elements of management information systems
  • Sexual reassignment surgery(SRS) - a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are changed to that of the other sex
  • Splenectomy - a procedure that involves the removal of the spleen
  • Stapedectomy - a surgical procedure of the middle ear performed to improve hearing
  • Thoracotomy - a surgical incision into the chest performed to gain access to the thoracic organs
  • Thrombectomy - the excision of an abnormal or dangerous thrombus (blood clot)
  • Thymectomy - an operation to remove the thymus gland
  • Thyroidectomy - the surgical removal all or part of the thyroid gland
  • Tonsillectomy - a surgical procedure in which the tonsils are removed
  • Tracheotomy - also called a tracheostomy; a surgical procedure performed on the neck to open a direct airway through an incision in the trachea (the windpipe)
  • Tubal ligation - informally known as getting one's "tubes tied"; a permanent, but sometimes reversible, form of female sterilization in which the fallopian tubes are severed and sealed in order to prevent fertilization
  • Ulner Collateral Ligament Reconstruction (UCL) - also known as "Tommy John surgery"; a surgical procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body
  • Ureterosigmoidostomy - a surgical procedure where the ureters, which carry urine from the kidneys, are diverted into the sigmoid colon; done as a treatment for bladder cancer
  • Vaginectomy - a medical procedure to remove all or part of the vagina; a treatment for vaginal cancer
  • Vascular surgery - the branch of surgery that occupies itself with surgical interventions of arteries and veins, as well as conservative therapies for disease of the peripheral vascular system
  • Vasectomy - a birth control method in which all or part of a male's vas deferens are surgically removed, thus sterilizing the patient
  • Vivisection - refers to the dissection of, or any cutting or surgery upon, a living animal
  • Vulvectomy - a gynecological procedure in which the vulva is partly or completely removed

References

  • Channel 4. 2006. Ancient Surgery. Retrieved October 24, 2007.
  • Silverthorn, D. 2004. Human Physiology, An Integrated Approach, 3rd ed. San Francisco: Benjamin Cummings. ISBN 013102153
  • Wilson, J. D., et al. 1991. Harrison's Principles of Internal Medicine, 12th ed. New York: McGraw-Hill, Inc. ISBN 0070708908


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